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NPI Code Detail

MEDICARE: JOHN PERKINS

MEDICARE: JOHN PERKINS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2390200000XStudent in an Organized Health Care Education/Training Program
3103T00000XPsychologist13571858-2501UT

General Provider Information

NPI Number : 1265097216
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN PERKINS
Provider Business Mailing Address
First Line : 750 N FREEDOM BLVD
Second Line :
City : PROVO
State : UT
Zip : 84601-1677
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 322 E 6TH AVE
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84103-2728
Country : US
Telephone Number : 612-590-0600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2019
Last Update Date : 09/16/2024

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